| NPI | 1225049968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA G79131) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA G79131) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G79131) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2021-10-14 |